Psychosocial risk factors are associated with high readmission rates, longer hospital stays
COLUMBUS, Ohio – A new study shows that psychosocial risk factors that impact a person's ability to cope with chronic stress are associated with significantly higher readmission rates and longer hospital stays among blood cancer patients undergoing hematopoietic stem cell transplantation (HSCT).
This, says, researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James), is a critical clinical concern and area of unmet need for patients who require intensive treatment to eradicate their cancer that should be addressed in a systematic way by the oncology community.
"Stem cell transplant can be a curative treatment for certain cancers, but it is a very long process that can put strains on a patient before, during and after the actual transplant," said Ashley Rosko, MD, an OSUCCC – James hematologist and senior author of the new study. "Just like we assess potential impact and risks of a patient's co-morbidities before pursuing a stem cell transplant, we saw a need to evaluate psychosocial vulnerabilities to identify those patients at the highest risk for complications and develop interventions to ensure the smoothest recovery possible."
Study Design and Results
The goal of this study was identify patients that might be at increased risk for complications during or after treatment based on non-traditional medical factors that influence overall health and wellbeing, such as depression and anxiety.
Researchers conducted an observational study of 395 patients undergoing stem cell transplant to treat acute leukemia, multiple myeloma, lymphoma and other cancers/disorders at the OSUCCC – James in Columbus, Ohio.
Stem cell transplantation involves collecting stem cells – which are produced in the bone marrow – either from the cancer patient (autologous) or a donor (allogeneic). Stem cells are then infused back into the patient after high dose chemotherapy cancer treatment is complete to help restore the bone marrow's ability to produce red and white blood cells that fight off infection.
Prior to treatment, all patients in this study had a psychosocial screening to identify factors affecting their ability to cope including: history of anxiety, depression, substance abuse, health behaviors, family social support, emotional tone, and mental status. Patients deemed at-risk were subcategorized into mild and moderate risk.
OSUCCC – James researchers found that 48 percent of all patients included in this observational study were deemed to be at risk. Psychiatric conditions (24 percent), poor health behaviors (16 percent) and poor coping history (13 percent) were the most common identified risk factors.
In addition, all patients with any degree of psychosocial vulnerability – regardless of race, disease type, remission status or type of stem cell transplant procedure – were at a higher risk for hospital readmission following HSCT and at-risk autologous transplant patients have a significantly longer length of stay.
The findings will be presented on Dec. 5, 2016, at the American Society of Hematology 2016.
"Hospital readmission in stem cell transplant patients is associated with poor overall survival, increased cost and worse quality of life so it is important that we do all that we can to identify these patients in advance of treatment to help them successfully navigate the treatment process," says Rosko. "Many of these psychosocial risk factors can be mitigated and managed to the benefit of the patient."
Researchers expect to continue this research through a prospective study aimed at identifying at-risk patients prior to therapy and offering a psychologist-led coping strategy intervention prior to treatment.
"We need to help our patients better cope with the chronic stress of a cancer diagnosis and treatment so that they are less likely to have setbacks in care due to additional illness," adds Rosko.
This research was supported as a clinical quality research initiative of The OSUCCC – James division of hematology. Co-authors of the study include first author Daniel Richardson, MD, Ying Huang, Patrick Elder, Joanna Newlin, Cyndi Kirkendall, Steven Devine, MD, Leslie Andritsos, MD, Don Benson, MD, PhD, William Blum, MD, Yvonne Efebera, MD, Craig Hofmeister, MD, Samantha Jaglowski, MD, Rebecca Klisovic, MD, Heather McGinty, PhD, Sam Penza, MD, Sumithra Vasu and Basem William, MD.
About The OSUCCC – James
The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute strives to create a cancer-free world by integrating scientific research with excellence in education and patient-centered care, a strategy that leads to better methods of prevention, detection and treatment. Ohio State is one of only 45 National Cancer Institute-designated Comprehensive Cancer Centers and one of only four centers funded by the NCI to conduct both phase I and phase II clinical trials on novel anticancer drugs. As the cancer program's 306-bed adult patient-care component, The James is one of the top cancer hospitals in the nation as ranked by U.S. News & World Report and has achieved Magnet designation, the highest honor an organization can receive for quality patient care and professional nursing practice. At 21 floors with more than 1.1 million square feet, The James is a transformational facility that fosters collaboration and integration of cancer research and clinical cancer care. For more information, please visit cancer.osu.edu.